Systematic review: 2011Havel: Cochrane Collaboration 2011Additional 17 studies identified: total 23N=3212, 1629 mortality outcomesSensitivity analysis of 10 studies with low risk of bias
On current high quality evidence:Noradrenaline is the probably vasoactive drug of choice.Adrenaline is equieffective, with transient metabolic effectsDopamine associated with adverse effects, particularly arrhythmiaDobutamine has no demonstrable benefitVasopressin may have catecholamine-sparing effects, but noclinical benefit in septic shockHydrocortisone …… unprovenDellinger: ICM 2012
The SURVIVE StudyMebazza: JAMA 2007Blinded MC RCTn=1320Primary outcome: 180d mortalitySecondary outcome: δBNPLevosimendan (12µg/kg + 0.1 µg/kg/min) x 2 h vs dobutamine (5-40 µg/kg/min)
ConclusionsAn body of higher-quality, investigator-initiated trials ofcatecholamines on patient-centred outcomes in critically illpatients is finally emerging.The is no evidence of superiority of any of the currently usedcatecholamines, used solely or in combination, overnoradrenaline or adrenaline on resolution of shock,development or resolution of organ failure or mortality.Catecholamine-sparing strategies with vasopressin andcorticosteroids have an undefined, unproven role.
InterpretationThe role of catecholamines for the treatment of shock isevolving from “rescue” therapy to “neurohormonalaugmentation” therapy in vulnerable patients.It is biologically implausible that synthetic catecholaminecompounds will produce improvements in patient-centredoutcomes.Current evidence-based guidelines and bundles will needrevision to accord with global considerations outside theimperative of industry.